Provider Demographics
NPI:1093912560
Name:HAYES, VIRGINIA S
Entity Type:Individual
Prefix:MRS
First Name:VIRGINIA
Middle Name:S
Last Name:HAYES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 HARRELSON RD
Mailing Address - Street 2:
Mailing Address - City:CLARKTON
Mailing Address - State:NC
Mailing Address - Zip Code:28433-8705
Mailing Address - Country:US
Mailing Address - Phone:910-862-5370
Mailing Address - Fax:
Practice Address - Street 1:412 E BROAD ST
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:NC
Practice Address - Zip Code:28337-8845
Practice Address - Country:US
Practice Address - Phone:910-862-4563
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC753156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8801930Medicaid
NC0679370001Medicare ID - Type Unspecified